Single-payer, health savings accounts, or managed care? Minnesota physicians' perspectives

Introduction: With uninsured Americans nearing 46 million and costs increases at 3-4 times general inflation, a renewed commitment toward providing efficient universal health coverage is emergent, including in low uninsurance/high disparity states (e.g. Minnesota). Despite physicians' vital role in health care, few studies assess their preferences regarding financing systems. Previously no survey assessed Minnesota physician attitudes toward health savings accounts (HSAs), single payer (SP), and managed care (MC). Data/Methods: Following IRB approval, a file of all 17,766 Minnesota-registered physicians from the Minnesota Board of Medical Practice was reduced to 13,770 (out-of-state addresses eliminated). A random-sample powered for 40% response was generated via a user-seeded random vector in Minitab Statistical Software (Release 14), sorting, and applying an appropriate step function. A paper survey (with online option) updating an instrument by McCormick et al. (2004) was distributed to 1061 physicians (12/6/05-2/13/06). (27 undeliverables were randomly replaced.) Queries included preferred system under a budget constraint, nonexclusive favorability toward price-tiered networks, HSAs, and SP; societal responsibility, work environment, administrative time, and demographics. 408 respondents (39.5%) closely approximated physician population parameters: within 0.6% by sex, 1.3% rural/metropolitan, and 0.4% to 2.6% across 4 practice categories (primary medicine, medical specialty, general surgery, surgical specialty). Contra possible nonresponse bias a sensitivity analysis (Microsoft Excel 2000) recalculated preference proportions by sex, geographical setting, and specialty. 4-point Likert scales converted to indicator variables for binary logistic regression models using chi-square significant predictors. Results: 63.6% believed SP would provide the best care for a given amount of money, 24.6% HSAs, only 11.8% MC (390 responding) – opposite empirical exposure. Female sex was significant for SP (76.0% to 58.8%, p=.003); male for HSAs (29.6% to 15.9%, p=.004). Urban most favored SP followed by rural and suburban (71.1%, 59.8%, 54.2%, p=.009). Rural favored HSAs over suburban and twice urban (34.1%, 31.8%, 17.3%; p=.002). MC preference was < 15% in all settings, lowest for rural (6.1%). 55.8% were generally favorable toward SP; 45.6% HSAs; only 19.7% toward price-tiered networks. 86.2% held it is society's responsibility via government to assure universal access to good care, regardless of ability to pay. Only 40.9% agreed that the private insurance industry should continue to play a major role in health care financing. 71.0%, somewhat to strongly agreed with reducing fees 10% for ‘very significant' paperwork reductions; 63.8% with a ‘fair' salary system. Physician preferences merit widespread inclusion in policy debates, with a need for further concretization of proposals.